Bismuth quadruple three-in-one single capsule three times a day increases effectiveness compared with the usual four times a day schedule: results from the European Registry on<i>Helicobacter pylori</i>Management (Hp-EuReg)
Authors: Ángeles Pérez-Aisa, Olga P Nyssen, Alma Keco-Huerga, Luís Rodrigo, Alfredo J Lucendo, Blas J Gomez-Rodriguez, Juan Ortuño, Mónica Perona, José María Huguet, Oscar Núñez, Luis Fernandez-Salazar, Jesus Barrio, Angel Lanas, Eduardo Iyo, Pilar Mata Romero, Miguel Fernández-Bermejo, Barbara Gomez, Ana Garre, Judith Gomez-Camarero, Luis Javier Lamuela, Ana Campillo, Luisa de la Peña-Negro, Manuel Dominguez Cajal, Luis Bujanda, Diego Burgos-Santamaría, Fernando Bermejo, Víctor González-Carrera, Ramón Pajares, Pedro Almela Notari, Javier Tejedor-Tejada, Montserrat Planella, Itxaso Jiménez, Yolanda Arguedas Lázaro, Antonio Cuadrado-Lavín, Isabel Pérez-Martínez, Edurne Amorena, Jesús M Gonzalez-Santiago, Teresa Angueira, Virginia Flores, Samuel J Martínez-Domínguez, Manuel Pabón-Carrasco, Benito Velayos, Alicia Algaba, Consuelo Ramírez, Enrique Alfaro Almajano, Manuel Castro-Fernandez, Noelia Alcaide, Patricia Sanz Segura, Anna Cano-Català, Natalia García-Morales, Leticia Moreira, Francis Mégraud, Colm O'Morain, Xavier Calvet, Javier P Gisbert
Journal: Gut (2023)

The recommended schedule for single capsule bismuth quadruple therapy (scBQT, Pylera) includes a proton pump inhibitor (PPI) two times a day and three scBQT capsules four times a day. Four times a day treatments are inconvenient and reduce adherence. In contrast, adherence improves with three times a day schedules. In clinical practice, many gastroenterologists use four capsule scBQT three times a day. However, the effectiveness and safety of this latter approach remain uncertain.To assess the effectiveness and safety of scBQT administered three times a day in the patients included in the European Registry on Helicobacter pylori Management (Hp-EuReg).All Spanish adult patients registered in the Asociación Española de Gastroenterología Research Electronic Data Capture (REDCap) database from June 2013 to March 2021 receiving 10-day scBQT were analysed. Modified intention-to-treat effectiveness, adherence and the safety of scBQT given three times a day were calculated and compared with the four times a day schedule. A multivariate analysis was performed to determine independent factors predicting cure of the infection.Of the 3712 cases, 2516 (68%) were four times a day and 1196 (32%) three times a day. Mean age was 51 years, 63% were women and 15% had a peptic ulcer. The three times a day schedule showed significantly better overall cure rates than four times a day (1047/1112, 94%; 95% CI 92.7 to 95.6 vs 2207/2423, 91%; 95% CI 89.9 to 92.2, respectively, p=0.002). Adherence and safety data were similar for both regimens. In the multivariate analysis, three times a day dosage, first-line therapy, use of standard or high-dose PPIs and adherence over 90% were significantly associated with cure of the infection.ScBQT prescribed three times a day was more effective than the traditional four times a day schedule. No differences were observed in treatment adherence or safety.